Frasier Crane and his brother, Niles, both practiced psychiatry on their popular NBC sitcom “Frasier.” Mob boss Tony Soprano had his therapist on HBO’s hit show “The Sopranos.” And HBO has even made therapy the focus of two recent shows — “Tell Me You Love Me” and “In Treatment.”

But all of these TV portrayals may actually make viewers less likely to seek psychological services themselves. That’s according to a new study by three Iowa State University psychologists.

ISU psychology professors David Vogel and Douglas Gentile collaborated with graduate student Scott Kaplan on the study of 369 Iowa State students. It explored how exposure to television shows may contribute to negative perceptions about psychological services that can lead to lower intentions to seek such services. They produced a paper titled “The Influence of Television on Willingness to Seek Therapy,” which was published in the March issue of the Journal of Clinical Psychology, a professional journal.

Unflattering portrayals of mental health professionals

Kaplan has conducted a related content analysis on television portrayals of mental health professionals. It found that they’re not favorable.

“Generally, it seems like therapists are portrayed unethically — like sleeping with the client, or implanting false memories, or talking about their clients outside the session,” Vogel said. “These are things that almost never happen with real therapists, but on a show — because they’re probably more exciting — they happen more frequently.”

“Therapists also often are portrayed as buffoons,” Gentile said. “That’s either by being the jokester, like Frasier, or by being the butt of jokes. In either case, these are not positive portrayals. They do not show the skill, expertise and ethics of professional therapists.”

But it’s not just the portrayal of the therapists that may be keeping people out of therapy. It’s also the portrayal of those who seek counseling on TV.

“If you examine the portrayal of the clients, it’s probably as bad or worse,” Vogel said. “So why would you seek therapy if you believe you’re going to be perceived negatively and you’re going to see someone who’s incompetent and not able to help you?”

Because dramas and comedies are the two types of shows that often portray psychologists and psychotherapy, the ISU psychologists asked respondents how often they watched TV comedy and drama shows. They also asked them to assess perceptions of the stigma associated with seeking professional help, attitudes toward therapy, their intentions to seek therapy for psychological and interpersonal concerns, and their feelings of depression.

TV ties to therapy stigma

The study found a positive correlation between viewers’ exposure to comedy and drama shows and their perceptions of stigma associated with seeking professional help. This stigma was then related to lower willingness to seek professional mental health services.

“One of the things that’s important to note about this particular study is that we showed that TV exposure was related to your perceptions of the stigma associated with seeking help, which has been found to be one of the main factors found from inhibiting people from seeking that help,” Vogel said. “So you perceive that yourself, and other people, would be crazy to go (to therapy).”

That’s a problem for those people who could really benefit from professional mental health services. According to Vogel, the most recent studies in the mental health field have found that about half of population experiences a situation in their lives where psychological therapy could be helpful — about 20 percent in a single year. But in a given year, only about 10 percent of the people who could benefit from therapy will seek help from a psychologist or other mental health professional.

“Mental health services are already vastly underutilized, and this cultural stigma is part of the reason,” Gentile said. “And this study suggests that this cultural stigma exists partly because of the way that psychologists and their patients are portrayed on television.”

[Mike Ferlazzo @ Iowa State University]

What’s more, car owners are predicted to cut back on driving in order to save money. Together, these changes in consumer behaviour could make an important dent in the US contribution to global warming, reducing annual carbon dioxide emissions by tens of millions of tonnes per year. The impact will be dramatic, says Chris Knittel, an economist at the University of California, Davis, who was involved in one of the studies.

The changes are being driven by record fuel prices in the US, where, at the end of April, the average price of gasoline stood at $3.65 per gallon, 20 percent more than in January and treble the price of a decade ago. Until recently, these increases did not seem to be having a consistent effect on the car market and fuel use. Though sales of SUVs in the US have been falling over the past few years, this decline has come on the back of years of rapid growth, and overall gasoline consumption has been increasing every year since 1991.

That could be about to change. Knittel and colleagues looked at data on 1.4 million car purchases over the past 10 years, comparing sales patterns with gas prices. They found that sales of the least fuel-efficient cars, such as SUVs and pick-up trucks, fell by 13 percent for every $1 per gallon increase in the price of gasoline. The biggest SUVs suffered the most, with sales dropping by over 25 percent for every dollar by which the gas price rose. And for every $1 hike in gas prices there was a corresponding 17 percent sales boost for the most efficient vehicles, such as compact cars and hybrids. Knittel estimates that over about a decade, such changes in buying habits could cut the amount of gasoline used by US drivers by around 7 percent for every $1 increase in its price.

Knittel’s findings, presented last month at the University of California Energy Institute in Berkeley, are in broad agreement with those of economist Kenneth Small of the University of California, Irvine. Small looked at data on US fuel consumption and prices over the past 40 years, and projected last year that the recent doubling in fuel prices would quickly lead to a 4 percent drop in the total mileage covered on the roads. In the longer term, as drivers continue to react to rising prices, he projects the size of the reduction will grow to around 20 percent (The Energy Journal, vol 28, p 25).

This would lead to a substantial reduction in carbon emissions. Small says that a $1 per gallon rise in gasoline prices, roughly that seen over the past two years, will result in motorists using 14 percent less fuel in the long term. That would avoid the release of some tens of millions of tonnes of CO2 per year, equivalent to roughly 2 percent of the country’s greenhouse-gas emissions for 2006. That is a hugely significant drop, close to the level of cuts that some nations are required to make under the Kyoto protocol.

Small’s prediction comes with major caveats, however. Gasoline prices are not expected to return to the lows of a decade ago, but could fall by 10 or 20 percent in coming years. And any US economic recovery will boost fuel consumption, partly through raising incomes, which would dilute the pressure on motorists to drive less. So while expensive fuel will rein in consumption, Small and other economists question whether this will be enough to cause an overall fall in emissions from cars.

It is also possible that politics will intervene before any of these effects has a chance to kick in. Presidential hopefuls John McCain and Hillary Clinton have reacted to consumer protests over soaring fuel prices by declaring that they would suspend federal gasoline taxes. “It’s a fantastically stupid idea,” says Roberton Williams, an economist at the University of Texas at Austin.

“But people don’t like high gas taxes, so it’s popular.”

[Claire Bowles @ New Scientist]

Approximately 20 percent of ACP members who are involved in direct patient care are in solo physician practices. And, about 50 percent are in practices of five or fewer physicians.

On July 1, physicians face a 10.6 percent cut in Medicare reimbursements. Another 5 percent cut is anticipated on January 1, 2009. The Sustainable Growth Rate (SGR) formula that is used to calculate Medicare payments to physicians was created in 1997 and ties physician payments to growth in the overall economy. When growth in physician expenditures exceeds growth in the economy, the difference is subtracted from physician payments. The SGR formula has led to scheduled annual cuts for six consecutive years.

Earlier this year, ACP surveyed its members to measure the impact of pending Medicare payment cuts on their practices and on their patients. The questionnaire asked internists to report on the changes they would be forced to make if Congress does not act. Although the survey was not designed as a scientific sample, almost 2,000 internists responded, providing ACP with first-hand accounts of how the SGR cuts are affecting millions of Medicare beneficiaries.

Dr Dale cited the story of one respondent, a Texas internist, who said:

“The practice of medicine is a calling and as such, my colleagues and I have endured more unfair revenue cuts than most businesses would have endured. Yet, a medical practice is also a small business, and there are limits to how much we can endure. We are now at the point where further cuts are not survivable. Just like any small business, our revenue has to exceed costs in order to survive. Despite everything that I have been able to do to cut costs, the margin of profit is now thin, and the proposed greater than 10 percent cut will put us out of business. The only option will be to downsize the practice and stop seeing all Medicare patients. I would hate this, but it will be the only option I have if Congress does not reverse the proposed cuts.”

ACP is asking Congress to avert the immediate SGR cut, but also go a step beyond. The College is asking Congress to set a timeline for completely eliminating the use of the SGR formula. ACP also wants Congress to direct Medicare, as part of replacing the SGR formula, to change payment policies to support patient-centered, physician-guided care management based on the patient-centered medical home model of care.

“Medicare patients deserve the best possible care,” concluded Dr. Dale. They also deserve a physician payment system that will help physicians deliver the best care possible, his testimony said.

[David Kinsman @ American College of Physicians]